Help for Hoarders

If you are over a certain age, you may remember hearing about the reclusive Collyer brothers, who died in 1947 surrounded by more than 100 tons of stuff they had hoarded over several decades. More recently, many people learned about hoarding from a reality TV show called Hoarders, which ran for nine years. As the drama ensued, viewers watched with horrified fascination as hoarders struggled with their chaos and compulsions.

Most of us have some hoarding tendencies, but hoarding disorder is another matter.

How is hoarding disorder different from collecting?

Collectors have a sense of pride in their possessions and experience joy when displaying and discussing their collections. They may be obsessive, but usually keep their items organized and manage the time and money they spend on their collections. What’s more, collecting is often a sociable endeavor, as collectors get together to show off their items.

Hoarders, on the other hand, are embarrassed about their possessions and don’t want people to see them. They usually feel ashamed or sad when they buy more stuff. Furthermore, the possessions flood their homes until it becomes difficult for them to live there. And hoarding can put people in debt as they buy more and more.

If you are wondering if you, a friend, or a family member simply has a cluttered home or has hoarding disorder, the Clutter Image Rating Scale from the International OCD Foundation can help you decide. It has photos of rooms with nine levels of clutter, to which you can comparethe rooms in question. Level four or higher suggests a need for professional help.

How does hoarding impair life?

Living spaces become pretty much unusable because of the piles of clutter. Hoarding can make it difficult to access the toilet, bed, and stove, thus interfering with hygiene, sleeping, and cooking. Clutter can be a fire hazard and impede emergency exits and emergency services, if needed. Neighbors may be affected by the hoarder’s poor sanitation and hygiene, such as with insect or mice infestation.

Because hoarders don’t want others to see their living spaces, when appliances or heating systems break down, they often don’t get them repaired. If the hoarder is married or lives with a partner, it could lead to divorce or separation, and if he or she has children, social services may intervene, with the possible loss of child custody.

What causes hoarding disorder?

Genetics, family history, personality traits, and environmental factors all appear to play roles, along with possibly traumatic or chronically stressful life experiences. Hoarding disorder tends to run in families, and studies in twins suggest that half the risk for hoarding may be inherited. Older people who have hoarding disorder often report having at least two relatives with hoarding symptoms.

People with the disorder may have dysfunctional beliefs and emotions about the importance of objects. They are often wrought with guilt, anxiety, fear, or sadness about discarding possessions and may believe that throwing them away would be like losing a part of themselves or their connections to key people or events in their earlier life. They have great difficulty in making decisions about letting go of things, often out of fear of making a mistake (“I might need them someday”).

How common is hoarding disorder?

It’s estimated that 2 to 6 percent of people have hoarding disorder, but as many as one-quarter of adults may have some hoarding symptoms. Apparently it occurs in all cultures. Men and women appear to be equally affected, but more women seek treatment for the disorder and report more severe symptoms. Symptoms often start to develop between ages 11 and 15 and become increasingly severe over the years. The disorder is most common in people over 55.

Is hoarding a mental disorder? How is it diagnosed?

Yes, though as with many mental conditions, there’s a spectrum of hoarding behaviors, not all of which constitute a mental disorder or require treatment. Hoarding disorder is included in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a stand-alone condition for the first time. DSM-5 says six criteria must be met for the diagnosis of hoarding disorder:

Accumulation of possessions that congests living areas and compromises their intended use. If living areas are uncluttered, it is only because of the intervention of family members, friends, or cleaners.

Significant distress or impairment in social, occupational, or other important areas of functioning as a result of hoarding.

The hoarding is not attributable to another medical condition, such as brain injury or cerebrovascular disease.

The hoarding is not better explained by the symptoms of another mental disorder (such as delusions in schizophrenia, cognitive deficits in dementia, or restricted interests in autism spectrum disorder).

Is hoarding disorder a type of OCD?

While the previous Diagnostic and Statistical Manual (DSM-4) included hoarding as part of OCD, DSM-5 categorizes it as a separate disorder, distinct from any hoarding compulsion found in OCD. According to a paper in the Journal of Psychopathology in 2015, hoarding disorder, unlike OCD, doesn’t involve obsessions or compulsions related to the hoarding. People with OCD don’t acquire so many possessions that their homes become unmanageable.

How is hoarding disorder treated?

Treatment should be tailored to the individual and what is most troublesome for him or her. The best evidence is for cognitive behavioral therapy. This helps people identify their dysfunctional beliefs regarding, for instance, their inability to discard objects, and teaches them how to develop more rational beliefs. It can include motivational enhancement whereby people are asked to determine their goals and values so they learn how their hoarding behavior conflicts with them.

Therapists may also use exposure techniques—for example, by having patients practice walking in and out of stores without purchasing anything. Practical techniques might involve suggesting that the hoarder take photos of possessions, which can be kept instead of the objects.

The efficacy of drug therapy is less certain. Selective serotonin-reuptake inhibitor (SSRI) antidepressants are sometimes used. Newer treatments include the dementia drugs donepezil (Aricept) and galantamine (Razadyne). Other promising treatments include noninvasive transcranial magnetic stimulation, which is also sometimes used to treat OCD.